Editor’s note: This commentary is by Falko Schilling, who is a consumer protection advocate with the Vermont Public Interest Research Group.
[R]ecently we’ve seen all sorts of conspiracy theories about why Gov. Shumlin decided to shelve his top legislative priority – the universal health care plan.
As one who worked closely with citizens, advocates, policy makers and the administration to advance this plan in concept, I’m not buying some of the most strident criticism. I’m convinced that the governor, and the many people he’s had working tirelessly for him on this, were absolutely committed to trying to reach our shared goal.
But to make the plan a reality, it needed to meet three tests. First, it needed to be viable from a substantive perspective. Could people get behind the plan based on the kind of coverage that they would receive? Second, it needed to be affordable and produce an economic benefit to the state. And third, it needed to be politically viable in the Legislature. And this third test, of course, depended a lot on the answers to the first two.
In the end, the analysis showed that the plan did not pass the second test, and therefore was sure to fail in the Legislature. That doesn’t mean that it can never work, but the answer isn’t as simple as just going with a “cheaper” version of the plan either.
A cheaper plan might have made some of the numbers look better, but it likely would not have provided the kind of benefits that Vermonters need.
The fact that the finances didn’t make the plan immediately viable doesn’t mean that important progress can’t be made this year. We’ve got to keep moving forward.
For instance, the administration proposed having Green Mountain Care cover approximately 94 percent of an individual’s health care costs, otherwise known as a 94 percent actuarial value plan. When the Legislature passed Act 48, it was their intent that the plan “provide a level of coverage that includes benefits that are actuarially equivalent to at least 87 percent of the full actuarial value of the covered health services.” Act 48 also set a floor of 80 percent actuarial value for Green Mountain Care.
But if you consider the reality that more than half of all Vermonters currently have plans that cover more than 90 percent of their health care costs, and 64 percent of all Vermonters have plans that cover more than 87 percent of costs, then it seems clear that 94 percent was the right choice from a policy perspective. How could we gain any traction behind a plan that was going to provide less coverage than most Vermonters currently receive?
The goal after all was to improve health coverage and outcomes for Vermonters. There was little chance of satisfying that first hurdle by going lower than the 94 percent actuarial value plan.
Another key policy decision now being questioned is the idea that all Vermont workers would be included in the new health care system. But it only makes sense to include these so called “commuters” in Green Mountain Care. A system where businesses and employees contributed to the program and could not get coverage would have been fundamentally unfair, and creating exemptions for payroll and personal contributions for out-of-state workers would have been complex and unworkable. The recommendation from the administration addressed these issues and avoided the pitfall of trying to limit the system to Vermont residents only.
No one thought that transitioning to a publicly financed universal health care system would be easy. What the governor’s proposal showed us is the work that still needs to be done in order to make the vision of Green Mountain Care possible. Most importantly, we need to find a way to bring out-of-control health care cost growth in line with the growth of our economy. The fact that the finances didn’t make the plan immediately viable doesn’t mean that important progress can’t be made this year. We’ve got to keep moving forward.
This major setback also doesn’t mean that we won’t eventually have universal health care in Vermont. This fight will continue, because it has to.
